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Cynthia Owsley, David Friedman, Julia Haller, David Lee, Jinan Saaddine, ; A Multi-Center Study of Diabetes Eye Screening in Community Settings in the United States. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1547.
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To examine the feasibility of using non-invasive, non-mydriatic fundus imaging in community-based clinic and pharmacy settings to screen for diabetic retinopathy (DR) among persons diagnosed with diabetes from underserved populations.
Five study settings were identified through CDC’s INSIGHT Collaborative Research Network: 2 primary health care clinics (community health center, Miami; county hospital clinic, Birmingham AL) and 3 pharmacies (Philadelphia; Baltimore; Mountain Air NM). Persons with diabetes presenting at these settings were invited to participate in a DR screening consisting of non-mydriatic fundus imaging performed by trained technicians. Images were electronically transmitted to the Wills Eye Telemedicine Reading Center and graded by trained staff using a system based on the UK National Health Service’s classification for DR. Results were relayed to site coordinators who notified participants of results. Those with positive findings were recommended to seek comprehensive eye care in a timely fashion; guidance was provided to participants who needed assistance in accessing follow-up eye care.
To date a total of 1,515 persons were screened (M age 54, SD 10). Race/ethnicity was 63% Black, 19% Hispanic, 11% White, 7% other. Self-reported time since diabetes diagnosis averaged 9 years. 43% reported that their most recent dilated eye exam was ≥2 years ago. 22% had DR (any type) in at least one eye, the vast majority being background DR (93%). Likelihood of DR increased with diabetes duration (p<.0001). The DR prevalence was higher in patients seen in clinic than in pharmacy settings (24% vs. 16%, p=.0004), regardless of race/ethnicity. DR prevalence was unrelated to recency of self-reported dilated eye exam. Other ocular lesions (OL) (e.g., cataract, hypertensive retinopathy) were noted by graders, with 44% of participants having OLs in at least one eye; half had cataract. 12% of images were deemed unreadable by the reading center, which was unrelated to cataract presence.
Diabetic retinopathy was detected in about 1 in 4 persons with diabetes screened in these primary care clinic and pharmacy settings serving underserved populations. We are currently examining the rate of follow-up comprehensive eye care in those who screened positive and collecting participants’ feedback on the screening process.
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